胎儿期三尖瓣生理性反流与心脏微小异常的超声研究

Ultrasonographic study on physiological fetal tricuspid regurgitation with heart minor anomaly

目的通过对胎儿期心脏微小异常以及三尖瓣生理性反流的超声观察,分析二者发生的相互关系以及胎儿期三尖瓣生理性反流的多普勒参数特点。方法胎儿超声心动图检测非选择性人群300例,经产前检查及产后随访除外胎儿及婴儿心脏疾病,胎儿期动脉导管提前收缩,胎儿心律失常以及孕妇妊娠糖尿病、妊高症等疾病。统计胎儿三尖瓣生理性反流和心脏微小异常的发生情况。彩色和脉冲多普勒检测胎儿期三尖瓣反流的面积、持续时间以及峰值流速。结果 300例胎儿中,胎儿期三尖瓣生理性反流136例,心脏微小异常者27例(包括心包腔少量积液6例,升主动脉宽于肺动脉主干6例,永存左上腔静脉4例,二尖瓣少量反流3例,肺动脉瓣少量反流7例,右心房内Chiari's网1例),心脏微小异常的病例中合并三尖瓣生理性反流者17例,统计分析发现微小异常组和非微小异常组之间,胎儿期三尖瓣生理性反流的发生率无明显差异(χ2=3.721,P=0.054),并且反流的面积、持续时间以及峰值流速亦无明显差异(P值分别为0.639、0.930和0.185)。结论胎儿期心脏微小异常存在与否,对胎儿期三尖瓣生理性反流的发生率无明显影响。胎儿期三尖瓣生理性反流的特点为反流面积较小,峰值流速较低且持续时间短暂,对胎儿心脏血流动力学无明显影响。

Objective To evaluate the relationship between physiological tricuspid regurgitation and heart minor anomaly by fetal echocardiography, and to analyze the characteristics of Doppler ultrasonography in physiological tricuspid regurgitation. Methods 300 cases of unselected population who came to our department for routine fetal echocardiography were selected as the object of study. The cases such as fetal heart disease, premature constriction of the ductus arteriosus during fetal life, fetal arrhythmias and pregnancies with diabetes or hypertension were excluded by obstetric examination and postpartum follow-up. The area, peak velocity and duration of physiological tricuspid regurgitation were measured by color and pulsed Doppler. Results In 300 cases, fetal physiological tricuspid regurgitation were found in 136 cases and fetal heart minor anomaly in 27 cases, include pericardial Effusion（n=6）, the size of ascending aorta wider than the main pulmonary artery（n=6）, left superior vena cava（n=4）, mitral regurgitation（n=3）, pulmonary regurgitation（n=7）, Chiari＇s network（n=1）. 17 cases of 27 associated with fetal physiological tricuspid regurgitation. Incidence of fetal physiological tricuspid regurgitation had no significant differences between the groups with and without heart minor anomaly （χ2=3.721, P=0.054）, neither were the area, duration and peak velocity of tricuspid regurgitation （The P values were 0.639, 0.930 and 0.185 respectively）. Conclusion Whether associated with or without fetal heart minor anomaly, the incidence of fetal physiological tricuspid regurgitation is not obvious change. The characteristics of fetal physiological tricuspid regurgitation were short in duration, small in area and low in peak velocity.